nc ds in adolescents sampi, sept 3, 2014

NCDs in Adolescents

TEODORO J. HERBOSA, MD Undersecretary

Department of Health

April 21, 2015Diabetes Education: Trending in the Community 2

Changing times Need social engineering

After 2 years-symptoms

Goes to health center for check up;

medicines prescribed for 3 weeks and

review

?

Lack of knowledge

Had stroke, ends up paralyzed Rushed to

hospital? ? ?

Purchased only for 3 days (expensive), consumed for 2 days, and left the rest in

a bottle

?

No symptoms/ no time/ no

money

NCD Story

Non Communicable DiseasesBurden of Disease (Global)- WHO

36M or 63% of global deaths were due to NCDs

6 million people die every year due to tobacco use

A person dies every 8 seconds from tobacco use.

Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally

320,000 people aged 15-29 years die annually from alcohol-related causes, resulting in 9% of all deaths in that age group.

Nearly 4% of all deaths are related to alcohol. Most alcohol-related deaths are caused by alcohol result from injuries, cancer, cardiovascular diseases and liver cirrhosis.

Non Communicable DiseasesBurden of Disease (Philippines)

10 Filipinos die every hour from smoking and second-hand smoking.

Trend towards foods higher in sugar and fat underscores double burden of under and over-nutrition. (WHO)

22.3% of Filipino adults are overweight (body mass index of 25 - 29.9 (Philippine Nutrition Facts and Figures 2011, Food and Nutrition Research Institute)

  Disease Number of Cases Male Female Rate per 100,000

population

1 Acute Respiratory Infection 1,584,056 785,262 798,794 1653.6

2 ALTRI & Pneumonia 569,768 281,668 288,100 594.8

3 Hypertension 338,214 174,229 163,985 353.1

4 Bronchitis 262,009 125,428 136,581 273.5

5 Influenza 221,810 109,130 116,498 231.5

6 Urinary Tract Infection 175,379 77,642 112,680 183.1

7 Acute Watery Diarrhea 150,354 58,881 72,812 157.0

8 TB Respiratory 47,991 27,756 21,417 50.1

9 Acute Febrille Illness 39,491 19,640 20,235 41.2

10 TB other forms 39,061 17,644 19,851 40.8

Ten Leading Causes of MorbidityFHSIS, 2011

Risk factors 1998 2003 2008 2013

Hypertension 21.0 22.5 25.3 22.3

Hyperglycemia 3.9 3.4 4.8 5.4

Overweight/Obesity

20.2 24.0 26.6 31.1

Smoking 32.7 34.8 31.0 25.4

Prevalence of Hypertension, Hyperglycemia, Overweight/Obese and Smoking (current smokers)

FNRI – National Nutrition Survey

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April 21, 2015Diabetes Education: Trending in the Community 10

April 21, 2015Diabetes Education: Trending in the Community 11

30-50% of deaths due to NCDs are pre-mature.....

Epidemiologic Transition

DEVELOPMENT

MO

RT

AL

ITY

Lifestyle/NCDs

InfectiousDisease

Omran et al 1970

Prevalence of Hypertension, Hyperglycemia, Dyslipidemia & Overweight (1998, 2003 and 2008 Philippine NNS, FNRI)

Risk factors 1998 2003 2008 Basis

Hypertension 21.0 22.5 25.3 SBP ≥ 140, DBP ≥ 90

Hyperglycemia 3.9 3.4 4.8 FBS > 126 mg/dL

Total cholesterol 4.0 8.5 10.2 ≥ 240 mg/dL

Triglycerides 8.7 9.4 14.6 ≥ 200 mg/dL

BMI (Overweight) 20.2 24.0 26.6 BMI ≥ 25.0

Dietary intake show Dietary intake show increased consumption of energy dense foods increased consumption of energy dense foods

high in fats and sugars,high in fats and sugars,

Almost the entire adult population has low levels of physical activity in all domains:

occupation, non-occupation, leisure,transportation.

Changing Eating Patterns The consumption of meat

(up 3.1 per cent) and poultry (up 4.3 per cent) has increased over the past three decades – and intake of healthier foods has fallen: roots and tubers by 2.6 per cent and fruit by 2.2 per cent.

‘Intake of fruits and vegetables has been on the downtrend because they’re expensive’, and also eating patterns have changed, with many people eating outside the home, and often eating fast food.

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April 21, 2015Diabetes Education: Trending in the Community 19

Cost of Treatment of NCDs

New estimates show that NCDs can impose larger costs than most communicable diseases in the Pacific

* In some countries, money spent on CVD alone can be one fifth of the total health expenditure

* Catastrophic effects are devastating for both families and health systems: early death, disability, household disruption, loss of income, diminished workforce and medical care expenditures

DOH INITIATIVES TO ADDRESS LIFESTYLE

RELATED NON-COMMUNICABLE DISEASES

Our Strategy

Philippine Action Plan for NCDs

AdvocacyAdvocacyResearch, Surveillance and EvaluationResearch, Surveillance and Evaluation

“Whole of Government” Response

•Political will•Political leadership•Healthy public policies and laws

Health Sector Response

•Health sector governance•Health sector leadership•Integration of NCD prevention and control into national health strategy

“Whole of Society” Response

•Community leadership•Intersectoral partnerships•Community mobilization

Health Systems Response

(Health Systems Strengthening)•Health workforce development•Health services organization/delivery•Financing•People-centered systems of care•Focus on prevention

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Status of NCD Prevention and Control Program

A. LEGISLATION

Passage of Sin Tax Law otherwise known as Anti-cancer Law

B. POLICIES

AO No. 2013 – 0005 or The National Policy on the Unified Registry Systems of the Department of Health (Chronic Non-communicable Diseases, Injury Related Cases, Persons with Disabilities, and Violence Against Women and Children Registry Systems)

AO No. 2012-0029 or The Implementing Guidelines on the Institutionalization of Philippine Package of Essential NCD Interventions (PhilPEN) on the Integrated Management of Hypertension and Diabetes for Primary Health Care Facilities

AO No. 2011-0003 or The National policy on Strengthening the Prevention and Control of Chronic Lifestyle Related Non-Communicable Diseases

FINANCIAL PROTECTION

Implementation of Primary Care Benefit Packages (PCB):

a. PCB 1 – consultation, screening and diagnostics for NCDs i.e. Visual Inspection Using Acetic Acid Wash (VIA)

b. PCB 2 - management and provision of medications for NCDs i.e. Complete Treatment Packs for DM and HPN

Z Packages for catastrophic illnesses i.e. breast cancer and ALL

Case payment rates for asthma and essential hypertension

23 Case Rates (No balance billing for Sponsored Program beneficiaries in

government hospitals)

TYPE Z (CATASTROPHIC DISEASES) BENEFIT PACKAGE

BENEFIT CASE RATE

Leukemia in Children Php 210,000.00

Breast Cancer 100,000.00

Prostate Cancer 100,000.00

Renal Transplantation 600,000.00

Coronary Artery Bypass Graft surgery 550,000.00

Surgery for total correction of tetralogy of Fallot 320,000.00

Closure of ventricular septal defect 250,000.00

Cervical cancer 120,000.00 - 175,000.00

• Can only be availed initially in PhilHealth accredited Level 3 or Level 4 government hospitals that have signed a contract on the provision of specialized care; • No balance billing policy will be implemented to members of the Sponsored Program; • In the future, for non-SP members, fixed co-pay for each condition will be paid on top of the packaged amount.

PHILPPINES: Most Filipino children not physically active during the school day, except in physical education classes. (NCBI)

• Less than a tenth of students surveyed were physically active for seven days for at least 60 minutes a day during the past week or during a typical week. (WHO)

• Nearly 30% of students spent three or more hours per day sitting and doing activities such as watching television, playing computer games or talking to friends. (WHO)

GLOBAL: Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally. (WHO)

• Around 31% of adults aged 15 and over were insufficiently active (men 28% and women 34%). (WHO)

Pilipinas Go4Health Website

www.go4health.ph

Social Media Accounts

News and updates about

Pilipinas GoHealth will be posted in these

social networking

sites

News and updates about

Pilipinas GoHealth will be posted in these

social networking

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Promote Pilipinas Go4Health!

Produce and display movement collateral in your establishments

Be a Go4Health Institution!As a company policy, declare the

establishment/school/agency as a “Go4Health” place, and the promotion of a healthy lifestyle as a

priority.

• Enforce restrictions on smoking in public places based on the Tobacco Regulations Act

• Enforce restrictions on selling tobacco products based on the Tobacco Regulations Act

• Make access to tobacco sellers and smoking places difficult

• Enforce restrictions on smoking in public places based on the Tobacco Regulations Act

• Enforce restrictions on selling tobacco products based on the Tobacco Regulations Act

• Make access to tobacco sellers and smoking places difficult

• Enforce restrictions on selling alcohol to minors• Avoid partnering with alcoholic brands for events and activities• Prohibit putting up of posters of alcohol brands in the premises

• Enforce restrictions on selling alcohol to minors• Avoid partnering with alcoholic brands for events and activities• Prohibit putting up of posters of alcohol brands in the premises

• Remove additives like MSG and lessen sodium and sugar in cooking

• Offer healthier menu; offer fresh fruits for dessert instead of pastries

• Offices should provide a short break in the morning to give those who missed out on breakfast a chance to grab a quick meal

• Remove additives like MSG and lessen sodium and sugar in cooking

• Offer healthier menu; offer fresh fruits for dessert instead of pastries

• Offices should provide a short break in the morning to give those who missed out on breakfast a chance to grab a quick meal

• Partner with sports or fitness facilities to offer services to employees at lower costs• Plan weekly sports events for the schools and offices

• Set challenges that would encourage students or employees to engage in more exercises

• Partner with sports or fitness facilities to offer services to employees at lower costs• Plan weekly sports events for the schools and offices

• Set challenges that would encourage students or employees to engage in more exercises

Support Healthy Lifestyle Programs

• Health Promotion

1. Belly Gud for Health – a 6 month period of risk assessment/physical activity/nutrition counseling for executives of DOH and other volunteer employees to achieve a desirable waist size

“Ala Stress” habit – 15-20 minute exercise done by employees every 3:00 pm

Fitness Camp

1 hour Aerobic exercises twice a week among DOH employees

Expansion of the Belly Gud program to other government and non-government agencies

2. Nutrition Labeling Initiatives – Front-of-Pack labeling (FOP): “Pinggan ng Kalusugan”

Activities can be led by Pilipinas

Go4Health partners!

Pilipinas Go4Health Activities

Our Pledge

We believe that every Filipino has the right to a healthy family, community, and country. As lead advocate for the nationwide healthy lifestyle movement, we work hand-in-hand with different sectors to provide options for healthy

living and make it accessible to as many people as possible.

Ultimately, Pil ipinas Go4Health hopes to contribute to successful nation and inclusive development by

encouraging Filipinos to embrace four key health habits: physical activity, proper nutrition, and the prevention or

cessation of smoking and alcohol consumption.

THANK YOU!